Archived: We Care Homecare Ltd

This inspection took place between 11 March 2015 and 1 April 2015. We gave notice of our intention to visit We Care Homecare Ltd’s office to make sure people we needed to speak to were available. Between our two visits on 11 March 2015 and 1 April 2015 we contacted people who used the service and members of staff by telephone.

We Care Homecare Ltd provides personal care services to people in their own homes. It covers a wide area in Portsmouth and surrounding districts, and provides services to older people and younger adults. At the time of our inspection there were 185 people receiving care and support from the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We Care Homecare Ltd had been without a registered manager since October 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are “registered persons”. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. When we visited the home the registered provider was managing the service.

When we last inspected the service in July 2014 we found it was failing to meet minimum standards in four areas: Care and welfare of people who use services, Staffing, Supporting workers, and Assessing and monitoring the quality of service provision. On this occasion we found that improvements had been made, but the service had not reached the standards required by the regulations.

Most people felt they were safe while their care workers were in their home, although a small number told us of incidents which suggested they were not safe all the time.

People were at risk because the provider did not prepare staff effectively to recognise and prevent abuse and avoidable harm. There were occasions when staff were not sufficiently prepared or experienced to deliver care safely, and occasions when one care worker attended calls where two were required. Records did not show that people received their medicines consistently at the correct time.

The registered provider and staff did not demonstrate an understanding of the Mental Capacity Act 2005. This provides a legal framework for acting and making decisions on behalf of people who lack the mental capacity to make particular decisions for themselves. This meant people were at risk of receiving care or support that was not in their best interests.

Staff were not consistently supported to deliver care and support by an effective system of supervision, appraisal and spot checks. Twenty-five per cent of staff had not had a supervision or appraisal, and a number of care workers told us they did not feel supported by the office.

There was a programme of induction and refresher training which the majority of staff had completed recently. People were supported to eat and drink where this was part of their care plan. The service helped people access other healthcare services when they needed to.

Most people found staff to be caring and considerate, and were able to express their views and participate in decisions about their care. In most cases people’s privacy and dignity were respected. However we found a small number of examples where this was not the case.

People did not consistently receive care and support which was based on their needs and assessments. Care plans were focused on tasks rather than people’s individual preferences, choices and needs. Late calls, missed calls and rushed calls put people at risk of not receiving timely or professionally delivered care.

People did not find the office responsive to requests and complaints. Communication between the office and clients and between the office and care workers in the field was often poor. Complaints were not recorded and followed up.

Staff and people who used the service had varying experiences of how well it was managed. Some staff were complimentary and found the service a good place to work. Others did not feel supported and had problems with communication, particularly when they needed to contact on call or out of hours support. Some people were satisfied with how the service was run, others were frustrated by poor communication and inadequate responses to comments and complaints.

The management organisation was not clear to all staff. The provider had systems for monitoring the quality of service provided but they were not always effective in identifying people’s concerns. Where concerns were identified they were not followed up and resolved.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponded to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of this report.